The impact of pulmonary tuberculosis on immunological and metabolic features of diabetic patients

Chen, Haijun; Су, Ли; Bao, Jinhua; Zhang, Kun; Li, Yuze; Mao, Enuo

doi:10.3389/fimmu.2022.973991

Cited by 9 publications

(6 citation statements)

References 31 publications

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“…Thus, some TBDM patients may have TB effects that dominate over those of DM, while others may have the opposite phenotype, with DM effects dominating over those caused by TB. The evolution of DM is an important factor in this regard [72,73]. Metabolic characteristics, such as the presence of a hyperglycemic and dyslipidemic environment, can affect the immune system response by interfering with the levels of inflammatory mediators and the development of T cell immunity [74][75][76].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Systemic Inflammation Before and After Standard Anti-tuberculosis Treatment in Patients With Active Pulmonary Tuberculosis and Diabetes Mellitus

López-González,

Martínez-Soto,

Avila-Cervantes

et al. 2024

Cureus

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Background Diabetes mellitus (DM) is a common comorbidity of active pulmonary tuberculosis (APTB) that increases the risk of treatment failure during anti-tuberculosis chemotherapy. Evaluating systemic inflammatory response could help determine differences in response to treatment between APTB patients and those with APTB and DM. Methodology To explore changes in systemic inflammation, measured by a set of inflammatory mediators in subjects with APTB and TBDM before and after six months of anti-tuberculosis chemotherapy, 30 APTB and nine TBDM subjects underwent cytokine testing, including interleukin (IL)-6, IL-8, IL-10, interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), and transforming growth factor-beta 1 (TGF-β1) by enzyme-linked immunosorbent assay, C-reactive protein by nephelometry, and sialic acid by colorimetric assay at baseline and following six months of standard anti-tuberculosis treatment. Sputum smear microscopy or molecular biology (Xpert MTB/RIF) was used for diagnosis, and sputum smear microscopy was performed monthly during the treatment of the patient with pulmonary tuberculosis to evaluate his evolution. Principal component analysis examined changes in the inflammatory status. Results Both groups showed negative sputum smear microscopy in the sixth month after starting anti-tuberculosis chemotherapy. TGF-β1 was found to be significantly higher in subjects with TBDM before treatment compared to APTB patients (p<0.001), and systemic inflammation continued only in TBDM subjects after treatment (accumulation and persistence of inflammatory mediators like IL-6, IL-8, IL-10, IFN-γ, TNF-α, TGF-β1, C-reactive protein, and sialic acid in blood). On the other hand, the mediators IFN-γ, C-reactive protein, and total sialic acid were found to be most influential in distinguishing pre- and post-treatment inflammatory response in subjects with APTB without DM. Conclusions Inflammatory mediators analyzed in combination, including IFN-γ, CRP, and total sialic acid, may be useful in evaluating the systemic inflammatory response in subjects with APTB and TBDM before and after anti-tuberculosis treatment. Determining these mediators revealed persistent systemic inflammation in TBDM subjects after six months of standard tuberculosis treatment, despite negative sputum smear microscopy results and good glycemic control. This suggests a need for inflammation-modulating therapies during tuberculosis control. Finally, monitoring sputum smear microscopy results alongside the determination of proposed inflammatory mediators (IFN-γ, CRP, and total sialic acid) are effective in evaluating the response to anti-tuberculosis treatment in APTB subjects without DM, warranting further investigation.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Systemic Inflammation Before and After Standard Anti-tuberculosis Treatment in Patients With Active Pulmonary Tuberculosis and Diabetes Mellitus

López-González,

Martínez-Soto,

Avila-Cervantes

et al. 2024

Cureus

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“…The heightened risk of PTB-DM comorbidity among males and the elderly may be due to factors such as increased social interactions, elevated rates of smoking and alcohol consumption, and dietary habits characterized by high salt and fat intake 27,33 . Additionally, the elderly encounter a decreased basal metabolic rate, increased secretion of β-cell and insulin, resulting in diminished compensatory function against glucose stimulation, thereby elevating the risk of positive aetiological results and comorbidity among this demographic 34,35 . Moreover, PTB-DM patients were more commonly identified through referrals or follow-ups rather than seeking clinical consultation, potentially influenced by China's diagnostic and management systems for PTB and the lifestyle patterns of the elderly populace.…”

Section: Discussionmentioning

confidence: 99%

Prevalence trends, population characteristics and treatment outcomes of tuberculosis combined with diabetes in southwest China: a register-based retrospective study

Kong,

Shui,

Zhang

et al. 2024

Preprint

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The global situation regarding the prevention and control of pulmonary tuberculosis (PTB) remains challenging. With the ongoing aging population and the increasing prevalence of chronic diseases, the epidemic of comorbid PTB and diabetes mellitus (PTB-DM) presents challenges to PTB control .This study aims to explore the epidemiological trends of PTB-DM in Southwest China and identify risk factors associated with adverse treatment outcomes, providing evidence to enhance TB prevention and control measures and improve patient treatment outcomes.This retrospective study used PTB case data from the PTB Information Management System within the China Information System for Disease Control and Prevention (CISDP). The trend in PTB-DM incidence was analyzed using the Joinpoint regression model, and population and clinical characteristics of patients were described using frequencies (n) and percentages. Group comparisons utilized chi-square tests, and risk factors for adverse treatment outcomes were explored using multivariable logistic regression models with stepwise backward selection based on Wald tests.The Joinpoint analysis revealed a declining trend in PTB incidence in Southwest China (AAPC = -10.22%, 95% CI: -11.49%~-8.94%), contrasting with a rapid increase in PTB-DM incidence (AAPC = 14.25%, 95% CI: 11.35% ~17.23%). The proportion of PTB-DM among PTB cases increased significantly from 2.96% to 12.28%, indicating a pronounced increase in the comorbidity prevalence of PTB-DM. PTB-DM patients were characterized by a higher proportion of males and elderly individuals, multiple positive aetiological results, and lower rates of proactive medical consultation. Among PTB-DM patients, successful outcomes accounted for 80.85% , while unsuccessful outcomes accounted for 19.15%.Although the number of PTB-DM patients with successful treatment outcomes increased overall (AAPC = 12.22%, 95% CI: 10.30% ~14.16%), the failure rate showed a gradual upward trend (AAPC = 14.18%, 95% CI: 6.53% ~27.67%). Analysis of factors associated with adverse treatment outcomes showed that advanced age, retreatment, referral, and positive aetiological results were risk factors for PTB-DM patients.Therefore, it is imperative to strengthen early screening and standardized treatment for key populations, such as the elderly population, and to implement more comprehensive and effective treatment and management measures for patients.

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“…Currently, the data on Chinese TB-DM patients are uncomprehensive. Several studies illustrated well the basic clinical characteristics and immunological features of Chinese patients with TB-DM based on a small Chinese population (11,12). Therefore, further studies are necessary to enrich the data of TB-DM patients in China.…”

Section: Introductionmentioning

confidence: 92%

Clinical features, immunologic parameter and treatment outcome of Chinese tuberculosis patients with or without DM

Tong,

Lai,

et al. 2024

Front. Med.

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BackgroundThe coexistence of diabetes mellitus (DM) and pulmonary tuberculosis (PTB) poses a significant health concern globally, with their convergence presenting a considerable challenge to healthcare systems. Previous research has highlighted that comorbidities can mutually influence and exacerbate immune disorders. However, there is a paucity of data on the impact of DM on immunological features and treatment responses in the TB population in China.MethodsFrom January 2020 to June 2022, 264 cases of pulmonary tuberculosis patients (82 DM patients and 182 non-DM patients) hospitalized in our center were selected. 80 patients with TB with DM (TB-DM) and 80 patients with TB without DM (TB-NDM) were enrolled into the final analysis by propensity score matching for age, gender and involved lung field at a ratio of 1:1. The clinical characteristics, immunological features and treatment response were compared between the two groups.ResultsAfter propensity score matching, no differences in the general features such as age gender, involved lung field, the incidence of retreatment and WBC count were found between the two groups. Compared to TB-NDM group, the TB-DM group exhibited a higher positive rate of sputum smear and incidence of cavitary lesions. Immunological features analysis revealed that the TB-DM patients had higher levels of TNF-α [pg/ml; 8.56 (7.08–13.35) vs. 7.64 (6.38–10.14) p = 0.033] and IL-8 [pg/ml; 25.85 (11.63–58.40) vs. 17.56 (6.44–39.08) p = 0.003] but lower CD8+ T lymphocyte count [cells/mm3; 334.02 (249.35–420.71) VS 380.95 (291.73–471.25) p = 0.038]. However, there was no significant difference in serum IL-6 concentration and CD4+ T lymphocyte count between the two groups. After 2 months of anti-tuberculosis treatment, 39 (24.4%) cases had suboptimal treatment response, including 23 (28.7%) TB-DM patients and 16 (20%) TB-NDM patients. There was no difference in suboptimal response rate (SRR) was found between the two groups (p = 0.269). The multivariate logistic regression analysis indicated that retreatment for TB [AOR: 5.68 (95%CI: 2.01–16.08), p = 0.001], sputum smear positivity [AOR: 8.01 (95%CI: 2.62–24.50), p = 0.001] were associated with SRR in all participants, and in TB-DM group, only sputum smear positivity [AOR: 16.47 (1.75–155.12), p = 0.014] was positive with SRR.ConclusionDM is a risk factor for pulmonary cavity formation and sputum smear positivity in TB population. Additionally, TB-DM patients is characterized by enhanced cytokine responses and decreased CD8+ T lymphocytes. The retreatment for TB and sputum smear positivity were associated with the occurrence of suboptimal treatment response.

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The impact of pulmonary tuberculosis on immunological and metabolic features of diabetic patients

Cited by 9 publications

References 31 publications

Evaluation of Systemic Inflammation Before and After Standard Anti-tuberculosis Treatment in Patients With Active Pulmonary Tuberculosis and Diabetes Mellitus

Evaluation of Systemic Inflammation Before and After Standard Anti-tuberculosis Treatment in Patients With Active Pulmonary Tuberculosis and Diabetes Mellitus

Prevalence trends, population characteristics and treatment outcomes of tuberculosis combined with diabetes in southwest China: a register-based retrospective study

Clinical features, immunologic parameter and treatment outcome of Chinese tuberculosis patients with or without DM

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